Hard flaccid syndrome (HFS), also known as hard flaccid (HF), is a chronic painful condition characterized by a semi-rigid

penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do n ...

at the flaccid state, a soft

glans The glans (, plural "glandes" ; from the Latin word for " acorn") is a vascular structure located at the tip of the penis in male mammals or a homologous genital structure of the clitoris in female mammals. Structure The exterior structure o ...

at the erect state,

pelvic pain Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain. If the pain lasts for more than six months, it is deemed to be chronic pelvic pain. It can affect both the male and female pelvis. Common causes in include ...

, low

libido Libido (; colloquial: sex drive) is a person's overall sexual drive or desire for sexual activity. Libido is influenced by biological, psychological, and social factors. Biologically, the sex hormones and associated neurotransmitters that act up ...

erectile dysfunction Erectile dysfunction (ED), also called impotence, is the type of sexual dysfunction in which the penis fails to become or stay erect during sexual activity. It is the most common sexual problem in men.Cunningham GR, Rosen RC. Overview of male ...

, erectile pain, pain on

ejaculation Ejaculation is the discharge of semen (the ''ejaculate''; normally containing sperm) from the male reproductory tract as a result of an orgasm. It is the final stage and natural objective of male sexual stimulation, and an essential componen ...

, penile sensory changes (numbness or coldness),

lower urinary tract symptoms Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra and, in men, the prostate. The term is more commonly applied to men—over 40% of older men are afected—but lower urin ...

, contraction of the

pelvic floor The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the lev ...

muscles, and psychological distress. Other complaints include

rectal The rectum is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. The adult human rectum is about long, and begins at the rectosigmoid junction (the end of the sigmoid colon) at the le ...

and perineal discomfort, cold hands and feet, and a hollow or detached feeling inside the penile shaft. The majority of HFS patients are in their 20s–30s and symptoms significantly affect one's quality of life. Sufferers typically report the onset of symptoms after trauma due to a mishap during

sexual intercourse Sexual intercourse (or coitus or copulation) is a sexual activity typically involving the insertion and thrusting of the penis into the vagina for sexual pleasure or reproduction.Sexual intercourse most commonly means penile–vaginal penetrat ...

or tough

masturbation Masturbation is the sexual stimulation of one's own genitals for sexual arousal or other sexual pleasure, usually to the point of orgasm. The stimulation may involve hands, fingers, everyday objects, sex toys such as vibrators, or combinatio ...

, specifically a traumatic injury at the base of the erect penis, possibly affecting the

dorsal artery of the penis The dorsal artery of the penis is an artery on the top surface of the penis. It is a branch of the internal pudendal artery. It runs forward on the dorsum of the penis to the glans, where it divides into two branches to the glans penis and the f ...

, the Bulbourethral artery, bulbourethral and the pudendal arteries, as well as the Pudendal nerve, pudendal and dorsal nerve of the penis. Penile sensory and textural changes, as well as changes in appearance, are hallmarks of the condition and serve to distinguish HFS from classic Chronic prostatitis/chronic pelvic pain syndrome, chronic pelvic pain syndrome or Benign prostatic hyperplasia, BPH. Both biological and psychological influences contribute to the condition by altering the Neurovascular bundle, neurovascular supply to the muscles of the pelvic floor and penis. One theory proposes that HFS is a result of an initial stress which triggers an abnormal fight or flight response resulting in increased sympathetic stimulation to the muscles of the pelvis via the Perineal branches of posterior femoral cutaneous nerve, perineal branch of the pudendal nerve. In turn, a surge of adrenaline, noradrenaline and cortisol is released from the efferent nerve fibers promoting increased blood flow to the Bulbospongiosus muscle, bulbospongiosus, Ischiocavernosus muscle, ischiocavernous and levator ani muscles as well as sustained muscle contraction which results in obstructed venous outflow from the penis via compression of the Deep dorsal vein of penis, deep dorsal vein and pelvic myoneuropathy secondary to neurogenic inflammation.

Treatment

Treatment may include medications for pain management, pelvic floor physical therapy, biofeedback, and stress reduction techniques. Men experiencing anxiety or depression may benefit from counseling.

References

{{Male diseases of the pelvis and genitals Ailments of unknown cause Chronic pain syndromes Men's health Penile erection Penis disorders Sexual dysfunctions Urologic pelvic pain syndrome

Treatment

See also

References